急性胆囊炎腹腔镜手术时机选择与费用关系

Relationship between opportunity and hospitalization expenses of laparoscopic cholecystectomy for acute cholecystitis

目的:探讨急性胆囊炎腹腔镜手术的时机选择,分析其与住院费用的关系。方法:回顾分析2004年1月至2010年12月为427例急性结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料。按胆囊炎发作至手术的时间分为早期手术组(ELC)、延期手术组(DLC)和择期手术组(SLC)。结果:3组患者并发症发生率差异无统计学意义(P>0.05)。ELC组手术时间平均(63.65±15.63)min,术中出血量平均(64.26±32.04)ml,平均住院(4.74±2.22)d,住院费用平均(10 504±1 982)元,中转开腹率2.7%。DLC组手术时间平均(94.24±29.51)min,术中出血量平均(174.95±64.39)ml,平均住院(8.00±3.83)d,住院费用平均(15 230±2 267)元,中转开腹率8.3%。SLC组手术时间平均(65.35±14.49)min,术中出血量平均(65.44±38.91)ml,平均住院(13.91±4.38)d,住院费用平均(19 032±4 495)元,中转开腹率2.2%。DLC组手术时间、术中出血量及中转开腹率明显高于ELC组、SLC组(P<0.05)。3组住院时间、住院医疗费用按病程时间依次增加(P<0.05)。结论:急性胆囊炎早期手术安全有效,并可减少住院时间,降低医疗费用,在治疗结果和生活质量上均具有优势。

Objective： To explore the relationship between opportunity and the hospitalization expenses of laparoscopic cholecystectomy（LC） in patients with acute cholecystitis. Methods：The clinical data of the 427 patients who suffered from acute calculous cholecystitis and were performed LC were analyzed retrospectively.All the 427 patients were divided into 3 groups on the basis of interval,which were early LC（ELC）,delayed LC（DLC） and selective LC（SLC）.The interval in the ELC（n=149）,DLC（n=96） and SLC（n=182） group of performing LC were within 72 h,during 72 h to 4 weeks,and beyond 4 weeks,respectively. Results：There was no significant difference in intraoperative and postoperative complications among 3 groups.The operative time in ELC,DLC and SLC group was（63.65±15.63） min,（94.24±29.51） min and（65.35±14.49） min,respectively.The intraoperative blood loss in the 3 groups was（64.26±32.04） ml,（174.95±64.39） ml and（65.44±38.91） ml,respectively.The mean hospital stay was（4.74±2.22） d,（8.00±3.83） d and（13.91±4.38） d,respectively.The hospitalization cost was（10 504±1 982） yuan,（15 230±2 267） yuan and（19 032±4 495） yuan in ELC,DLC and SLC group respectively.The rate of conversion to laparotomy was 2.7%,8.3% and 2.2%,respectively.Mean operation time,blood loss and the conversion rate to an open procedure in DLC group were more than those in the other groups.Total hospital stay and cost of the ELC,DLC and SLC group increased,accordingly. Conclusions：ELC for acute cholecystitis appears safe and effective,shortens the total hospital stay and cost,and has advantages in treatment outcome and life quality.